New research points to added benefits of physical activity

Regular physical activity improved depression symptoms in patients with CHD, inflammatory markers and diabetes mortality rates.

Issue: September 2012

The beneficial effects of regular physical activity are well known and extensively researched. Now, three recently published studies demonstrate added benefits of regular physical activity, beyond weight loss alone.

Exercise, CHD and depression

Data published in the Journal of the American College of Cardiology showed that increased physical activity decreased depressive symptoms in clinically depressed patients with CHD.

The Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy (UPBEAT) study included 101 patients with CHD and elevated depressive symptoms. Participants were assigned to 4 months of aerobic exercise three times per week; 50 mg to 200 mg of sertraline (Zoloft, Pfizer) daily; or placebo.

After 16 weeks, participants in the exercise and sertraline groups demonstrated considerable improvement in depressive symptoms vs. the placebo group. Whereas the placebo group experienced a mean –4.5 reduction in Hamilton Rating Scale for Depression scores, the exercise and sertraline groups experienced mean reductions of –7.5 and –6.1, respectively.

Researchers also examined the effect of exercise and medication on CV biomarkers, including heart rate variability, endothelial function, baroreflex sensitivity, inflammation and platelet function. Exercise and medication yielded greater decreases in heart rate variability vs. placebo, and exercise resulted in greater reductions in heart rate variability vs. sertraline.

“Symptoms of depression are common in CHD patients and exercise may be a viable alternative to antidepressant medication in successfully reducing depressive symptoms,” James A. Blumenthal, PhD, of the department of psychiatry and behavioral science, Duke University Medical Center, told Cardiology Today. “It would also be important for physicians to monitor patients’ progress, and those patients who exhibit a worsening of depressive symptoms may require more intensive mental health intervention.”

Leisure-time activity and inflammatory markers

Middle-aged adults who engaged in regular leisure-time physical activity for more than a decade had lower markers of inflammation and enhanced CV health, according to new results from the Whitehall II cohort study.

More than 4,200 participants (mean age, 49 years) reported the duration and frequency of their leisure-time physical activities, including brisk walking, gardening, cycling, sports, housework and home maintenance. Researchers analyzed CRP and interleukin-6 at baseline assessment in 1991-1993, and again assessed physical activity and inflammatory markers in 1997-1999 and about 11 years later.

Physically active participants had lower CRP and interleukin-6 levels at baseline. This difference remained stable over time compared with participants who rarely adhered to physical activity guidelines during 10-year follow-up. Participants who changed from inactive to active exercisers achieved lower inflammatory markers at follow-up, according to a press release.

Mark Hamer

“An increase in physical activity over the study period was also associated with lower inflammatory markers, irrespective of initial activity levels,” Mark Hamer, PhD, associate professor of epidemiology and public health at University College in London, told Cardiology Today. “Thus, becoming active in mid-life can still have benefits for CV health since participants in this study were all aged 50 to 60 years.”

Overall, 49.1% of participants met the standard physical activity recommendations for CV health (2.5 hours per week of moderate to vigorous physical activity). The rate reached 83% in subsequent phases of the study, according to the release.

Hamer said the researchers’ longitudinal data are stronger than previous shorter or cross-sectional studies, which have looked at the association between physical activity and inflammatory markers.

Physical activity and diabetes mortality

Researchers for the European Prospective Investigation Into Cancer and Nutrition (EPIC) study found a lower total mortality risk in physically active patients with diabetes. The lowest mortality risk was discovered in moderately active patients vs. physically inactive patients (HR=0.62; 95% CI, 0.49-0.78 for total mortality; HR=0.51; 95% CI, 0.32-0.81 for CVD mortality).

Leisure-time physical activity was also associated with a lower total mortality risk, and walking was associated with a lower CVD mortality risk. Results of a high-low meta-analysis revealed that the highest levels of total and leisure-time physical activity and walking were linked to a lower risk for total and CVD mortality compared with those who engaged in less physical activity.

“Even those undertaking moderate amounts of activity were at appreciably lower risk for early death compared with inactive persons,” Diewertje Sluik, MSc, and colleagues wrote in Archives of Internal Medicine.

During the prospective analysis, 13% of patients died after a median follow-up of 9.4 years. Of those who died, 28% died of CVD.

The EPIC cohort comprised 519,978 adults aged 35 to 70 years from 23 study centers in European countries. Sluik and colleagues investigated whether physical activity (total, leisure and walking time) was associated with CVD and total mortality in a portion of this patient population (n=5,859).

For more information:

Blumenthal JA. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.04.040.
Hamer M. Circulation. 2012;doi:10.1161/CIRCULATIONAHA.112.103879.
Rozanski A. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.05.015.
Sluik D. Arch Intern Med. 2012;doi:10.1001.2012.3130.

Disclosures:

Drs. Blumenthal, Hamer, Rozanski and Sluik report no relevant financial disclosures. The study by Hamer and colleagues was funded by the British Heart Foundation. The UPBEAT study was supported by a grant from the National Heart, Lung and Blood Institute.